Member Services Representative

Work Schedule

• Monday through Friday, 8:00am to 5:00pm
• Schedule is 8:00am to 5:00pm with opportunity to work from home if desired after training period

Benefits Package

• Single or Family Health Insurance with discounted premium rates for wellness program participation
• 401k with immediate matching (50% on the dollar up to 7% of pay + additional annual Profit Sharing)
• Flexible Paid Time Off Program (24 days off/year)
• Medical and Dependent Care Flex Spending Accounts
• Life insurance, Long Term Disability Coverage, Short Term Disability Coverage, Dental Insurance, etc.

What You'll Be Doing

• Answer inbound and outbound telephone calls in a professional, courteous, and timely manner
• Respond to member and provider inquiries regarding: Medical, dental, vision, and pharmacy benefits
• Claims status and claims processing
• Claim denials and appeal processes
• Prior authorizations and referral requirements
• Eligibility and enrollment status
• Premium payments and billing questions
• Provider network participation
• Explanation of Benefits (EOBs) and Explanation of Provider (EOP’s)
• Coverage limitations and exclusions
• Interpret, review, and enter member and authorization data and supporting documentation into core business processing systems to support Member Services operations
• Maintain working knowledge of claims administration processes, including the ability to review, analyze, process, calculate, and adjudicate claims in accordance with internal policies, procedures, and processing guidelines
• Complete all additional assigned projects and duties